1. The large intestine/colon is about ___ long and begins in the lower right side where the ___ joins the ____
    • 5ft
    • ileum
    • cecum
  2. How does the large intestine/colon travel
    Up the ascending colon, crosses obliquely left at the hepatic flexure travels across the transverse colon, then turns at the splenic flexture to descend down the descending colon into the pelvis
  3. At the brim of the pelvis, the descending colon makes an S shaped curve called the _____ then becomes the ____
    • sigmoid colon
    • rectum
  4. The rectum lies next to the
  5. The rectum is firmly attached to the ____ by the peritoneum and ends about 2 inches below the tip of the _____ where it becomes the anal canal
    • sacrum
    • coccyx
  6. The _____ is formed by the lsat 2-3 inches of the large intestine
    anal canal
  7. the anal canal is guarded by 2 spincters
    internal and external anal sphincters
  8. Instead of villi like the small intestine, the large intestine is made up of several pouches called
  9. Many ____ inhabit the colon and can break down some of the substances that escape the actions of enzymes
  10. Although the large intestine has little to no digestive functions, is serves to ____ and ____ from the remaining chyme and forms and stores the ____
    • reabsorbs water
    • electrolytes
    • feces
  11. Rectal CA is ranked ___ in the US for men and women in incidence and ____ for overall death
    • 3rd
    • 2nd
  12. What is the peak age for rectal ca
    50 or older
  13. What are causes for rectal ca
    • High fat diet
    • low fiber diet
    • obesity
    • smoking
    • alcohol
    • low activity
    • familial
    • polyposis
    • chronic ulcerative colitis
  14. Whar are symptoms of rectal ca
    • # 1 BLOOD IN STOOL
    • rectal bleeding
    • change in pooing
    • pencil poo
    • tenesmus (spasms)
    • N&V
    • obstruction
  15. How is rectal ca detected
    • Physical exam
    • radiographic with contrast
    • endoscopic
  16. What determines the size, mobility, location from the anal verge and rectal wall involvement with rectal ca
    • Digitla exam (finger)
    • Proctosigmoidoscopy
  17. What tests are done to evaluate metastatic disease of rectal ca
    • chest xray
    • CT
    • MRI
    • PET/CT
    • lab studies
  18. What tumor marker will rise if you have rectal ca
    • CEA
    • carcinoembryonic antigen
  19. What % of lesions are adenocarcinoma if large intestinal ca
  20. How is rectal ca staging done
    TNM or Dukes
  21. What route of spread does rectal CA take
    • Direct ( penetrates bowel wall)
    • lymphatic
    • blood
    • peritoneal seeding
  22. In rectal CA if the tumor penetrates the sub mucosal layer, which nodes are affected?
    • In an orderly fashion starting with
    • perirectal
    • internal iliacs
    • common iliacs
    • paraaortic
    • scv
  23. What is the #1 met for rectal CA
  24. For rectal ca, which surgery option will save the sphincter
    • Low anterior resection
    • 6-12 cm from the verge
  25. Which surgery option for rectal ca will not save the sphincter
    • abdominoperineal resection APR
    • distal 5 cm
  26. Which chemo drugs are used with rectal ca
    • 5 FU
    • gemcitabine
  27. If chemo is used to treat rectal ca with radiation which drugs are used
    • 5FU
    • leucovorin
    • FOLFOX
  28. What is the 5 year survival rate for rectal ca
  29. Which radiation technique is used for rectal ca
    • 3 or 4 field technique
    • AP, PA, RT, LT lateral
  30. For rectal CA what is the field design for AP/PA
    • Top- L4-L5 interspace
    • Bottom- bottom of obturator foramina or 3-5 cm below tumor
    • Lateral- 2cm lateral to pelvic brim and inlet
  31. For rectal CA what is the field design ofr Rt-LT laterals
    • Top- L4-L5 interspace .
    • Bottom- bottom of obturator foramina or 3-5 cm below tumor
    • Anterior- Anterior edge of femoral head
    • Posterior- 2cm behind sacrum
  32. What are different ways to simulate a patient to treat for rectal ca
    • Supine or prone but prone will allow for gluteal fold reduction
    • full bladder allows you to save the small bowell
    • empty bladder
    • vaginal marker
    • contrast
    • wire scar for anal verge
  33. What are external beam doses for rectal ca
    4500 cGy to large field and 540-1440 cGy boost which you add to the 4500
  34. For rectal CA what is the IORT dose
    1000-2000 cGy single fraction
  35. What are some acute side effects when treating rectal ca
    • small bowel toxicites
    • diarrhea
    • cramps
    • bloatin
    • proctitis
    • bloody or mucus discharge
    • dysuria
    • leukopenia and thrombocytopenia
    • moist desquamation
  36. What are chronic side effects for treating rectal ca
    • persistent diarrhea
    • increased bowel frequency
    • proctitis
    • urinary incontinence
    • bladder atrophy
    • enteritis
    • adhesions
    • obstructions
  37. Cancers of the anus occur more frequently in
  38. Large bowel cancers are _____% of all cancers
  39. What is the median age for anal ca
  40. What age does the incidence for men to increase for anal ca and why
    • <45
    • homosexuality
    • anal sex
  41. How long is the anus
    3-4 cm long
  42. What type of cells are in the anus
    • columnar epithelium (adenocarcinoma)
    • dentate line
    • squamous cell
  43. What are the clinical presentation for anal ca
    • rectal bleeding
    • pain
    • change in pooing
    • feeling a mass
    • discharge
  44. How is anal ca detected
    • physical
    • anoscopy
    • protoscopic exam
  45. What is the pathology for anal ca
    80% are squamous cell
  46. How is staging done for anal ca
    TNM and based on size and depth of tumor
  47. How are anal ca tumors spread and which nodes are affected
    • direct or lymphatics
    • above the dentate line (internal iliac)
    • below the dentate line (inguinal nodes)
  48. What treatment is used for anal ca
    • Radiation and/or chemo
    • surgery is reserved for salvage only
  49. What are the chemo drugs used for anal ca
    5 FU and mitomycin C
  50. What are treatment fields for anal ca
    AP/PA of 4 field technique with electrons to the inguinal nodes (these are a very superficial treatment)
  51. For anal ca, if using radiation alone, what is the dose
    6000-6500 cGy boost/shrinking field is 4500 cGy
  52. For anal ca, if doing radiation and chemo, dose is
    4500 cGy with boost/shrinking field s 5940-6940 cGy
  53. What are the side effects for treating anal ca
    • moist desquamation
    • N&V
    • diarrhea
    • bone marrow suppression
  54. Which organs are at risk when treating anal ca
    • bladder
    • small bowel
    • femoral heads
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